COMMUNICATION IN HEALTHCARE

The story chosen for discussion from the examples, was example 3, a discussion regarding an elderly patient and members of her family. Mention was made of family members having received multiple, very confusing messages from various members of staff about procedures of assessment and treatment. Family members also encountered members of staff who were uncommunicative, and there had been a lack of questioning of family members regarding the condition of the patient when healthy at home. Furthermore, the patient was not treated by the doctor with dignity and respect and that lead to the experience being a very humiliating for both the patient and members of her family. Also, numerous questions were asked by the doctor that the patient considered humiliating and ridiculous and little or no humanity and sympathy was shown to the sick person. The doctor had not been actively listening to the patient and, therefore, the scenario can be considered as having presented various situation wherein communication with the elderly sick patient had been ineffective. The discussion then can be seen as one that highlights the need to identify obstacles to effective communication. The of communication chosen is barriers to effective communication e.g disability /conflict/socio-economic issue/language/cultural .

It is very important that there is good and proper communication between patient and healthcare provider as that aids in the building of rapport and a sense of trust which leads to enhanced care quality for the patient and better adherence with the treatment. If there is a hindering of communication, then common understanding will not be reached and there will be a failure to achieve satisfaction in the patient and family; so, ultimately, barriers to communication impact upon patient care in a negative way (Albahri et al., 2018; Al-Sheikh and Iqbal, 2020). Communication processes are considered within communication theory. All living beings need forms of communication through some process or other (Van Ruler, 2018). Three ‘lenses’ can be used to consider the workings of communication processes. Firstly, communication can be seen through a sole direction with a sender constructing or attempting to reconstruct meanings formed by recipient(s). Secondly, 2-way communication is when at least two parties work in the association to develop new meanings. Thirdly, omnidirectional processes are those where there is continuous development of meaning (Zerfass et al., 2018).

The communication process is one in which there is sharing of information amongst people in order to enable the exchange of ideas and thoughts. Also, good communications enable the acquisition of better understanding with recognition and respect shown for the emotions and feelings of others. In order to promote patient health, it is essential for there to be good communication within healthcare. It has been shown that when there is appropriate, good quality communication then there is enhanced safety for a patient and improvement in health outcomes. The right forms of communication reduce danger of malpractice within healthcare institutions. So, it may be considered that effective communication is a key aid in the treatment of patients and helps professionals to provide care that is more patient-centred (Howick et al., 2018; Hardman and Howick, 2019). Various types of communication may include different techniques of questioning and helpful paraphrasing. To acquire significant information about the condition of a patient, a healthcare provider need to ask questions of members of the family as well as the patient; this gathering of data enables patient needs to be more fully understood and then process can be more satisfactorily tailored. If, however, there is a lack of accuracy and clarity in communication, obstacles can block the acquisition of valuable, relevant information that could have helped with the assessment of the patient and appropriate diagnosis (Christalle et al., 2019). Within our case, the doctor failed to ask the patient or family the helpful questions required; as such, it can be considered that the communication witnessed between parties was, in fact, very poor. Both patient and members of her family had high levels of dissatisfaction with regard to the healthcare and the questions that the doctor did put forward.

Within healthcare settings, there is a need for paraphrasing to facilitate communication through ensuring the correct and clear information is exchanges and to ensure no miscommunication mishaps occur between patient and healthcare provider. Active listening is required so misleading data is not gathered and used for inappropriate treatment; such obstacles in communication could lead directly to harm to a patient (Christalle et al., 2019). Within the scenario given, the patient had not been listened to properly by the doctor, and information had not been paraphrased. In fact, the doctor continuously talked over the patient resulting in her being unable to communicate adequately about her ailments and leading to her having reduced satisfaction levels. So, in order to acquire the necessary information with effective communication, there is a need for paraphrasing and an appropriate style of interviewing (Christalle et al., 2019; Chi, Pian and Zhang, 2020).

The first communication barrier seen within our case study was the showing of insufficient levels of humanity and empathy by the doctor resulting in the patient and family feeling that the healthcare provider was not demonstrating sufficient respect and emotional intelligence for a relationship of trust; there was compromised communication here. It has been noted that communication ought to be clear, with the engendering of feelings of having been respected within a patient helping to reflect that high care standards are, indeed, in place (Health and Care Professions Council, 2014). There is a need for the professional to have empathy for a patient to help the gathering of relevant information and, ultimately, the provision of better standards of care (Decety, 2020). With such empathy, the sick individual is helped in feeling safer and more comfortable in the care of the provider of the health service(s). If empathy is shown by the professional then a patient is more likely to assume due care and attention is in place and, thus, a therapeutic and positive relationship is established between parties. In addition, empathic practice with proper communication helps to lower the volume of complaints of malpractice that could have arisen (Davalos-Batallas et al., 2020; Decety, 2020).

A second communication barrier seen within the case study involved the sense that the doctor had spoken over the patient who felt unable to get her thoughts and feeling across. It can be traumatic for a patient to feel they are not being taken seriously and/or disrespected, stigmatised or mocked. Furthermore, a patient can feel their emotions and feelings are not been afforded their due value and/or ignored(Schinkel et al., 2016). Within the healthcare setting, such a patient may perceive there is insufficient consideration for their autonomy and that may further result in feelings of embarrassment and shame and psychological illness. However, if empathic practice is fostered, more healthy relationships can develop along with better care quality for the patient concerned and, to accompany that, the patient adherence and sense of autonomy can be promoted and enhanced along with patient satisfaction; this enhancement in practice would lead to issues of dissatisfaction and distrust being overcome (Rocque and Leanza, 2015; Jalil et al., 2017).

Language barriers can also affect communication. Indeed, language barriers can have significant implications to the costs and quality of healthcare and can result in health disparities since there is disadvantage to a patient who does not speak the same language as the healthcare provider, with a failure in understanding potentially valuable information So, the language barrier may well result in much worse health outcomes (Al Shamsi, 2020; Slade and Sergent, 2020). Conflict can be a further communication obstacle, with it resulting in poorer decision making and less coordination between patient, doctor and the healthcare team. Also, it impacts upon task completion and lowers performance levels amongst the individuals involved and that has bad outcomes for a patient (Jerng et al., 2017). In addition to a lowering of the quality of care, there can be increases in the rates of medical error. Also, direct and/or indirect costs would be borne by the patient in a situation of conflict and healthcare providers would have more feelings of stress and potential burnout. So, it may be considered that patient becomes compromised within a conflict scenario within a healthcare setting. So, there is a need for improvement to the communication channels for effective resolution of actual conflicts or avoidance of potential ones (Saridi et al., 2019).

Effective communication between the patients and care providers is crucial in acquisition of important qualitative and quantitative data regarding patient’s current health and wellbeing, past medical history, background and genetic history of specific illness (Anderson et al. 2019). Here in the case study, there was no questioning to the patient and the family members by the doctors as well as care staffs regarding the background, pre-medical history and genetic history of patients, which can pose potential barriers in making clear and effective health assessment of the patient. Evidences base report has showing that there are many NHS complaints against the poor communication made by the NHS staffs that interfere with the authentic as well as valid health assessment of patient (medicalxpress.com, 2020). In the case study as most of the care staffs are uncommunicative regarding collecting the important about patient’s health and background this will interfere with the effective health assessment of patient.

As mentioned by Hassan (2018.), family involvement is crucial in developing effective communication between care providers and the patients, in which doctors and health staffs are able to acquire the important information from the family members of patients that are not possible to provide by the patient, such as the details of behaviour, activities, approaches, likes, dislikes and choices of the patient. Under NICE (2015), in the case study the doctors and nurses need to include the family members of the elderly patient while communicating with him regarding his previous health condition, preferences, lifestyles, regular habits and pre medical history, which will assist the doctors to maintain a transparent information delivery system among the health professionals, patients and the family members (resolution.nhs.uk, 2020).

Under NICE (2015), while it comes to develop effective and healthy communication in healthcare, care providers must ensure that the overall communication will be transparent and well-constructed that will use proper facts and contexts to make the effective health assessment and disease management of patients [NICE, 2015]. While maintaining effective communication with elderly patient, doctors must ensure that they must not use the blanket or noncommittal statement that can exaggerate patient and his family members (www.mariecurie.org.uk, 2016). Here in the case study doctors have shown the highly unprofessional and unethical behaviour by making the blanket statement that pose overstress on the elderly patients and his family members. In this context, the situation could be managed if the doctors and the care staffs must follow the NICE (2018) guidelines under which they must use such sentences that are strictly relevant to the health condition and treatment of patients, additionally, as the patients is aged in the case study, doctors and the care staffs must use polite and understandable language that can be easily interpreted and understood by the patient rather than using the abusive, harsh and confusing language.

Under NMC (2015), care staffs must ensure that they work under their level on competence and professional knowledge to ensure the safety of patients [NMC, 2015]. In the case study, the care authority needs to ensure that all the care staffs are highly compatible to the communication needs of the aged patient. Here the care mangers need to find out that which care staffs are the uncommunicative during the discussion with patient and family members that hampers the overall health assessment and development of care plan for the patient. In the case study, care manager must find out whether the care staffs understand and follow the guidelines of Health Care Acts (HCA) such as Health and social care act 2015 to improve the overall communication with the aged patient and his family members to improves the overall car outcomes (research.tees.ac.uk, 2018).

In the case study the assessment procedure made by doctors for the elderly patients was considered as humiliating to the grandchildren of the patients as the questions that were asked to patients were baseless which lack the minimum humanity and sensitivity. Under NICE (2018), the questions that are asked to the patients for the assessment purpose must be appropriate and relevant to the treatment process and current health condition of patients [NICE, 2018]. Here in the case study, the behaviour of doctors and care staffs regarding asking question to the elderly patient was highly unprofessional and unethical as they do not follow the NICE guidelines in terms of maintaining relevant and effective communication with showing proper respect and dignity to the patient.

Here in the case study the complainant thinks that doctors were just showing off to the retinue that he is performing his duty by asking question tom patient for assessment purpose. Here the complainant finds out the questions are ridiculous because as per complainant the questions were not relevant and appropriate in terms of collecting the important information from patients to carry out the useful health assessment. Under NICE (2018), doctors must ask such as question that will be needed for carrying a good health assessment of patient. In the case study the questions that doctors asked were ridiculous as they lack the important information such as question about the background of the patient. On the contrary the term ‘retinue’ also is critically argued by the Abdulai et al. (2019), in which they stated that, in case of developing effective communication and assessment, care providers must develop the understandable, respectable and dignified questions that will not have any chances of humiliation to patient or show off to the retinue. Here in the case study the presence of a care manager was needed who can witnessed the entire question answer process and can report the issue to the HR regarding the matter (www.bbc.com, 2018).

Under NMC (2015), while maintaining effective communication with patients, health professionals must include the family members at the best interest and permission of the patient. In this context, although the case study the claimant complaints against the doctors and care staffs to not includes family members in the case process, here the power of attorney in providing the answer of question is on the patient’s hand.

Under NICE guidelines the risk effective communication is important in assisting the systematic care delivery to patients by reducing the risk of liability. In the case study, the complainants compare the case to the Lord Mancroft which pose questions on the ability and proficiency of the NHS staffs in maintaining their professional conducts and accountability while making effective communication with patients in the case study.

Here in the case study, it has been claimed that although patients talked across about including the family members, the care staffs did not ask the family members regarding many facts that are associated with developing effective care plan for the patient. This incident represents the high level of mis-communication and lack of transparent and systematic information delivery system among the patient, care staffs and the doctors and family members.

As mentioned by Hassan (2018), the mode of communication is different as well as specific to the different types of health needs of patients. In the case study, if the patient had broken foot or the stroke, then the overall communication and assessment process would be completely different such as making X ray of the foot and collecting information about the premedical history and current health condition of the patient. In this context Howick et al. (2018) mentioned that care professionals must develop the clear and concise communication that will assist the care providers to collect the information that are best suited to the current health needs of patients.

To conclude, it may be stated that our case scenario put forward various examples of ineffective or improper communication. The healthcare team and doctor failed to communicate effectively with family members and the patient herself and, as a result, both patient and family feel there was a lack of empathy shown by the healthcare provider and they remain unsatisfied. The transfer of information within a communication process enables a person to acknowledge and understand the feelings and thoughts of another or others. However, when that fails to occur, the patient safety and care are compromised. Lack of humanity and empathy in the manner of the doctor with regard to the feelings of the patient and members of her family was the first communication noted from within the case study. Secondly, it was noted that the doctor had been talking over the patient so that she felt unheard and disrespected. Additional barriers that may result in poor health outcomes were noted as being the language barrier and conflict in the relationships between doctor, patient or healthcare team. If there is removal of those barriers, then better quality of care could be provided to patients and, consequently, improvements seen in health status.

Continue your exploration of Color-Coded Guidelines and Hygiene Policies with our related content.

References

Abdulai, M., Alhassan, A.R.K. and Sanus, K.M., 2019. Exploring dialectal variations on quality health communication and healthcare delivery in the Sissala District of Ghana. Language and Intercultural Communication, 19(3), pp.242-255.

Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S. and Al Kalbani, T. (2020). Implications of language barriers for healthcare: A systematic review. Oman Medical Journal, 35(2), e122, Retrieved from https://doi.org/10.5001/omj.2020.40

Albahri, A. H., Abushibs, A. S. and Abushibs, N. S. (2018). Barriers to effective communication between family physicians and patients in the walk-in centre setting in Dubai: A cross-sectional survey. BMC Health Services Research, 18(1), 637, Retrieved from https://doi.org/10.1186/s12913-018-3457-3

Al-Sheikh, M. H. and Iqbal, M. Z. (2020). Communication skills for medical professionals: Perspectives from the Middle East. Effective Medical Communication, Springer, Singapore,215-225.

Anderson, R.J., Bloch, S., Armstrong, M., Stone, P.C. and Low, J.T., 2019. Communication between healthcare professionals and relatives of patients approaching the end-of-life: A systematic review of qualitative evidence. Palliative medicine, 33(8), pp.926-941.

Chi, J., Pian, W. and Zhang, S. (2020). Consumer health information needs: A systematic review of instrument development. Information Processing & Management, 102376. Retrieved from https://doi.org/10.1016/j.ipm.2020.102376

Christalle, E., Zill, J. M., Frerichs, W., Härter, M., Nestoriuc, Y., Dirmaier, J. and Scholl, I. (2019). Assessment of patient information needs: A systematic review of measures. PloS One, 14(1), e0209165. Retrieved from https://doi.org/10.1371/journal.pone.0209165

Davalos-Batallas, V., Vargas-Martínez, A. M., Bonilla-Sierra, P., Leon-Larios, F., Lomas-Campos, M. D. L. M., Vaca-Gallegos, S. L. and de Diego-Cordero, R. (2020). Compassionate engagement and action in the education for health care professions: A cross-sectional study at an Ecuadorian University. International Journal of Environmental Research and Public Health, 17(15), 5425, Retrieved from https://doi.org/10.3390/ijerph17155425

Decety, J. (2020). Empathy in medicine: What it is, and how much we really need it. The American Journal of Medicine, 133(5), 561–566, Retrieved from https://doi.org/10.1016/j.amjmed.2019.12.012

Guttman, O.T., Lazzara, E.H., Keebler, J.R., Webster, K.L., Gisick, L.M. and Baker, A.L., 2018. Dissecting Communication Barriers in Healthcare: A Path to Enhancing Communication Resiliency, Reliability, and Patient Safety. Journal of patient safety.

Hardman, D. and Howick, J. (2019).The friendly relationship between therapeutic empathy and person-centred care. European Journal for Person Centered Healthcare, 7(2), 351-357,10.5750/ejpch.v7i2.1689.

Hassan, I., 2018. Avoiding medication errors through effective communication in healthcare environment. Movement, Health & Exercise, 7(1), pp.113-126.

Health & Care Professions Council(2014). Professionalism in healthcare professionals. Retrieved from https://www.hcpc-uk.org/globalassets/resources/reports/professionalism-in-healthcare-professionals.pdf

Howick, J., Moscrop, A., Mebius, A., Fanshawe, T. R., Lewith, G., Bishop, F. L., Mistiaen, P., Roberts, N. W., Dieninytė, E., Hu, X. Y., Aveyard, P. and Onakpoya, I. J. (2018). Effects of empathic and positive communication in healthcare consultations: A systematic review and meta-analysis. Journal of the Royal Society of Medicine, 111(7), 240–252, Retrieved from https://doi.org/10.1177/0141076818769477

Howick, J., Moscrop, A., Mebius, A., Fanshawe, T.R., Lewith, G., Bishop, F.L., Mistiaen, P., Roberts, N.W., Dieninytė, E., Hu, X.Y. and Aveyard, P., 2018. Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. Journal of the Royal Society of Medicine, 111(7), pp.240-252.

Jalil, A., Zakar, R., Zakar, M. Z. and Fischer, F. (2017). Patient satisfaction with doctor-patient interactions: A mixed-methods study among diabetes mellitus patients in Pakistan. BMC Health Services Research, 17(1), 155, Retrieved from https://doi.org/10.1186/s12913-017-2094-6

Jerng, J. S., Huang, S. F., Liang, H. W., Chen, L. C., Lin, C. K., Huang, H. F., Hsieh, M. Y.and Sun, J. S. (2017). Workplace interpersonal conflicts among the healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center. PloS One, 12(2), e0171696. Retrieved from https://doi.org/10.1371/journal.pone.0171696

Marler, H. and Ditton, A., 2020. “I'm smiling back at you”: Exploring the impact of mask wearing on communication in healthcare. International journal of language & communication disorders.

medicalxpress.com , (2020), Sharp rise in NHS negligence claims for lack of informed consent available at :< https://medicalxpress.com/news/2020-03-sharp-nhs-negligence-lack-consent.html> [Accessed 19 Match, 2020]

research.tees.ac.uk, (2018), Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of shoulder impingement syndrome — Teesside University's Research Portal, available at:https://research.tees.ac.uk/en/publications/evidence-based-clinical-guidelines-for-the-diagnosis-assessment-a-3 [accessed 2017]

resolution.nhs.uk, (2020), NHS Resolution’s successful claims mediation service set to continue with award of new three-year contract - NHS Resolution available at: [Accessed 2 Jun, 2020]

Rocque, R. and Leanza, Y. (2015). A systematic review of patients' experiences in communicating with primary care physicians: Intercultural encounters and a balance between vulnerability and integrity. PloS One, 10(10), e0139577. Retrieved from https://doi.org/10.1371/journal.pone.0139577

Saridi, M., Panagiotidou, A., Toska, A., Panagiotidou, M. and Sarafis, P. (2019). Workplace interpersonal conflicts among healthcare professionals: A survey on conflict solution approach at a General Hospital. International Journal of Healthcare Management, 1-10, Retrieved from https://doi.org/10.1080/20479700.2019.1661114

Schinkel, S., Schouten, B. C., Street Jr, R. L., van den Putte, B. and van Weert, J. C. (2016). Enhancing health communication outcomes among ethnic minority patients: the effects of the match between participation preferences and perceptions and doctor-patient concordance.Journal of Health Communication, 21(12), 1251-1259, Retrieved from https://doi.org/10.1080/10810730.2016.1240269

Slade, S. and Sergent, S.R. (2020).Language barrier.StatPearls.StatPearls Publishing: United States of America.

Van Ruler, B. (2018). Communication theory: An underrated pillar on which strategic communication rests. International Journal of Strategic Communication, 12(4), 367-381, Retrieved from https://doi.org/10.1080/1553118X.2018.1452240

www.bbc.com , (2018), Poor communication fuels rise in NHS complaints - BBC News available at: [Accessed 9 November, 2012]

www.bbc.com, (2017), NHS negligence claims hit £1.4bn - BBC News available at:https://www.bbc.com/news/uk-england-36327310 [accessed 29 September, 2016]

www.mariecurie.org.uk , (2016), Poor communication in the NHS wastes public funds, available at: [accessed 29 February, 2016]

Zerfass, A., Verčič, D., Nothhaft, H. and Werder, K. P. (2018). Strategic communication: Defining the field and its contribution to research and practice. International Journal of Strategic Communication, 12(4), 487-505, Retrieved from https://doi.org/10.1080/1553118X.2018.1493485